Clinical Scorecard: Haemodynamic Responses in Adults Post-Fontan: A Comparison of Obesity, Overweight, and Normal Body Mass Index Through Retrospective Invasive Exercise Assessment

At a Glance

Key Highlights

• Adults post-Fontan with obesity have worse aerobic capacity (lower peak VO2) compared to those with overweight/normal BMI.
• Obesity is associated with increased systemic flow, higher pulmonary artery and wedge pressures, and lower arterial oxygen saturation at rest and during exercise.
• Haemodynamic changes in obese post-Fontan patients mirror those observed in the obesity phenotype of heart failure with preserved ejection fraction.

Guideline-Based Recommendations

Diagnosis

• Use body mass index (BMI) to categorize patients into obesity (>30 kg/m2) and overweight/normal (≤30 kg/m2) groups.
• Perform invasive exercise cardiac catheterization and non-invasive cardiopulmonary exercise testing to assess haemodynamics and exercise capacity.

Management

• Consider addressing obesity and its cardiometabolic sequelae in adults post-Fontan to potentially improve haemodynamics and outcomes.
• Preliminary evidence suggests GLP-1 receptor agonists may be safe and effective for weight loss in adults with congenital heart disease.

Monitoring & Follow-up

• Monitor exercise capacity via peak oxygen consumption (VO2) and invasive haemodynamic parameters during rest and exercise.
• Track arterial oxygen saturation and filling pressures to assess cardiopulmonary status.

Risks

• Obesity increases risk of elevated filling pressures, decreased oxygen saturation, and reduced exercise tolerance in post-Fontan patients.
• Weight gain is associated with increased cardiovascular events in adults with congenital heart disease.

Patient & Prescribing Data

Adults post-Fontan with obesity and overweight/normal BMI

Weight loss interventions, including GLP-1 receptor agonists, appear promising but require further study to confirm impact on haemodynamics and clinical outcomes.

Clinical Best Practices

• Regularly assess BMI and cardiopulmonary exercise capacity in adults post-Fontan.
• Incorporate invasive haemodynamic evaluation during exercise to better understand physiological impact of obesity.
• Address obesity proactively given its association with adverse haemodynamics and exercise intolerance.
• Consider multidisciplinary approaches including cardiology, nutrition, and physical therapy to manage obesity and improve functional status.

References

• Editorial comment on obesity and congenital heart disease